Modified Ertl osteomyoplasty for terminal overgrowth in childhood limb deficiencies

Terminal overgrowth continues to be a problem in children with amputations. Many operative treatment methods have been proposed, but no consensus has been reached regarding the procedure of choice. Six patients underwent a modified Ertl procedure for the treatment of terminal overgrowth in seven residual lower limbs (one bilateral). All these patients were skeletally immature. The average age at index procedure was 5 years 9 months (range, 1 year 3 months-6 years 11 months). Revision was necessary in four patients, with one patient requiring two revisions of the same limb. The modified Ertl osteomyoplasty can be performed safely in children, but appositional overgrowth may continue through the tibiofibular synostosis. The procedure is not recommended in skeletally immature patients.